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Investigation Finds Pattern of Problems for Elder Care in Assisted Living

July 30, 2013 at 12:00 AM EDT
Hundreds of thousands of elderly Americans live in assisted living centers across the nation. A.C. Thompson of ProPublica shares an excerpt from his FRONTLINE documentary "Life and Death In Assisted Living," and some troubling cases of elder care from his investigation.

JEFFREY BROWN: Finally tonight, troubling cases of elderly care, or lack of it, at some assisted living centers.

Nearly three-quarters-of-a-million Americans reside in more than 30,000 facilities.They’re the subject of an investigation on tonight’s Frontline, done in partnership with ProPublica.

A.C. Thompson is co-author of a series of reports for ProPublica and correspondent on tonight’s program.He joins us now.

Well, welcome to you.

And first, for purposes of definition, tell us what you were looking into.How are you defining assisted living?

A.C. THOMPSON, Frontline/ProPublica:So, assisted living is the niche of senior housing that’s between living at home on your own and living in a nursing home.

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So these are people who need some help, they can’t live independently anymore, but they don’t necessarily need full-on around-the-clock medical care.So in an assisted living facility, it’s more like a home, it’s more like an apartment, and what you’re getting typically is help with your medication, help with your meals, help to get to the bathroom or dressing if you need it.

JEFFREY BROWN: So what did your reporting show you about the general problems in many institutions?

A.C. THOMPSON: You know, first off, a lot of these facilities are great.

But what we also found was that there was a pattern of problems that spanned the country.And what we kept seeing were allegations and citations for a lack of staffing, not enough workers, a lack of training, workers who weren’t trained enough, medication errors, people getting the wrong drugs over and over again.

These were the kind of things that we saw, and these were the things that worried us about the industry as it evolves.

JEFFREY BROWN: You focused on one leading company, Emeritus, and you report on a number of very horrific-type stories.

I want to show a clip that focuses on one issue.It’s called memory care centers.Just tell us briefly what those are and what you were looking at.

A.C. THOMPSON: The memory care units or memory care facilities are places that are specially designed for people with Alzheimer’s, other forms of dementia.

The problem that we found was they weren’t always keeping those seniors safe.

JEFFREY BROWN: All right, let’s look at — let’s look at that clip.

KELLY SCOTT, Emeritus Senior Living:This is our program.We call it our Join Their Journey program.And this is where we’re caring for folks with dementia.

And it’s really a specialized program to meet their needs.We find out a lot about who they are as individuals.And then the day is set up around what is purposeful and meaningful to them as individuals.

WOMAN: It’s ready, 350.

A.C. THOMPSON: But some question whether memory care units like this one provides enough care.

WOMAN: Has anyone got a shovel?

WOMAN: You’re going to have a memory care unit.That’s a good marketing tool for families.A., there’s demand and you’re trying to keep occupancy up.And, B., you can charge more for memory care.

I mean, all you have really done is created rooms around a courtyard, but, still, that’s nice.And it’s much safer.But then they say they have got staff who are trained to do memory care.And that’s where it starts to kind of fall apart, because the staff are generally not well-trained to do dementia care.

A.C. THOMPSON: And lay out for me.If we’re here in Carmel Valley, we’re at your facility, what would the typical training consist of for somebody in this facility?

KELLY SCOTT: Who’s working particularly in memory care?

A.C. THOMPSON: In the memory care unit.


For our staff that works in memory care, they are going to go through what we call general orientation, which everybody in the community would go through.And then we have an eight-hour class that’s the Join Their Journey class.And that’s really where we cover everything from disease process, to how we serve a meal slightly differently to folks who have differently to folks who have dementia, to how to engage, how to approach, how to communicate, overcoming some communication barriers at time.

A.C. THOMPSON: So the eight-hour intro is sort of the minimum?

KELLY SCOTT: That’s our company standard is going to be the eight-hour.

WOMAN:Eight hours?That’s nothing.Who’s going to explain this is what the disease is, this is the impact that it has on people’s physical health and on their behaviors?You have got to know how to interpret nonverbal cues that something’s going on with this resident because they can’t tell you verbally, you know, in the same way that a 2-year-old can’t tell you or a 1-year-old.

I mean, you have got to do a lot of training for memory care units.You can do great care.You just — you got to know how.

JEFFREY BROWN: Well, so, A.C., that goes to one question, training.

You also documented some cases of very serious neglect, including some deaths.What did — the company at the focus here, Emeritus, what was their response to your report?

A.C. THOMPSON: The company’s perspective is that what we have highlighted are a series of isolated incidents.And they say these aren’t reflective of how the company does business and the care it provides.

In their opinion, they are providing great care, and what they say is that their violations, their state regulatory violations are declining.

JEFFREY BROWN: Well, speaking of regulations, one of the issues that you’re pointing to here is the regulatory system.Explain how that works or doesn’t work.

A.C. THOMPSON: You know, that was the thing that really surprised us in many ways.So I live in California.

And in California, if you want to find out what’s going on in these facilities — and we have more than 7,000 of them in this state — you can’t find that out online.The state Web site doesn’t have that information.You can’t get the inspection reports or any pertinent details.

You have got to set up an appointment, go to a state office, go through a bunch of paper files to figure out what’s going on in these facilities, if they have been cited for neglect, for abuse, for any other problems.Another thing that we saw a lot of — and it was, frankly, astounding to us — are cases like the death of George McAfee.

George McAfee was an NFL Hall of Famer.He developed dementia.He was in an Emeritus facility in Georgia.He drank toxic dish washing liquid.Apparently, he didn’t realize what it was.It was supposed to be locked up, but it wasn’t, and he died as a result. He had chemical burns.

The state of Georgia says, OK, we’re going to fine Emeritus for this death.The fine is $601 for Mr. McAfee’s death and an unrelated medication error — $601. 

JEFFREY BROWN: Well, just in our last minute, A.C., to the extent that this is clearly a growing phenomenon as the population ages, having looked into this, what do you think people need to know that they don’t know at this point?

A.C. THOMPSON: You know, I think that they absolutely need to research as much as possible, even if it means going to a state office and digging through files, the history of the facility that they’re considering moving into or having a loved one moved into.

They need to contact the state ombudsman where they live and see if there have been consumer complaints that have been verified at these facilities.And some states actually are technologically savvy and you can do this online and check out these facilities online in some states, but those steps absolutely need to be taken by consumers.

JEFFREY BROWN: And the stories you heard, the people you talked to, your sense was, they didn’t know that?

A.C. THOMPSON: You know, people are baffled often times.

The laws vary from state to state.The definitions for assisted living vary from state to state.And people are paying $3,000 or $4,000 or $5,000 or $10,000 a month, so they expect that they’re going to get high-quality care.And that doesn’t always happen.

JEFFREY BROWN: All right, A.C. Thompson of ProPublica and “Frontline,” thanks so much.

A.C. THOMPSON: Thanks for having me on.

JEFFREY BROWN: And you can watch the full story on “Frontline” airing on PBS stations tonight.